health it beyond hospitals (september 15, 2016)
TRANSCRIPT
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Nawanan Theera-Ampornpunt, M.D., Ph.D.
Healthcare CIO Program
Ramathibodi Hospital Administration School
Sep. 15, 2016 SlideShare.net/Nawanan
Except where citing other works
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Stakeholders in Health Care
Patient
Providers
Policy-Makers
Public
Payers
Diagram modified from Supachai Parchariyanon’s 4Ps Concept
• High bargaining
power
• Benefit with
improved quality in
fee-for-service
• Needs to satisfy many “bosses”
• Faces up-front costs in health IT
investments
• Long-term benefits depend on
payment schemes
• Require data for
policy-making
• Limited budget
• Often face
bureaucracies
• Highly political
• Concerns about resource allocation &
community’s well-being, but not
necessarily individual patients
• Directly benefits from
improved quality of care
• Knowledge gap between
patient & providers
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The Intersection
Clinical Informatics
Public Health
Informatics
Consumer Health
Informatics
Patients &
Consumers
Providers &
Patients
Policy-Makers,
Payers, Public
(Also providers)
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Public Policy in Informatics: A US’s Case
1991: IOM’s CPR Report published
1996: HIPAA enacted
2000-2001: IOM’s To Err Is Human & Crossing the Quality Chasm published
2004: George W. Bush’s Executive Order establishing ONCHIT (ONC)
2009-2010: ARRA/HITECH Act & “Meaningful use” regulations
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Political Support Behind Health IT
“...We will make wider use of electronic records and other
health information technology, to help control costs and
reduce dangerous medical errors.”
Source: Wikisource.org Image Source: Wikipedia.org
President George W. Bush
Sixth State of the Union Address
January 31, 2006
?
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U.S. Adoption of Health IT
• U.S. lags behind other Western countries (Schoen et al, 2006;Jha et al, 2008)
• Money and misalignment of benefits is the
biggest reason
Ambulatory (Hsiao et al, 2009) Hospitals (Jha et al, 2009)
Basic EHRs w/ notes 7.6%
Comprehensive EHRs 1.5%
CPOE 17%
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President Obama Backs Health IT
“...Our recovery plan will invest in electronic health records and new technology
that will reduce errors, bring down costs, ensure privacy, and save lives.”
President Barack Obama
Address to Joint Session of Congress
February 24, 2009
Source: WhiteHouse.gov
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American Recovery & Reinvestment Act
Contains HITECH Act
(Health Information Technology for
Economic and Clinical Health Act)
~ 20 billion dollars for Health IT investments
Incentives & penalties for providers
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U.S. National Leadership
David Blumenthal, MD, MPP
National Coordinator for
Health Information
Technology
(2009 - 2011)
Farzad Mostashari, MD, ScM
National Coordinator for
Health Information Technology
(2011 - 2013)
Robert Kolodner, MD
National Coordinator for
Health Information Technology
(2006 - 2009)
David Brailer, MD, PhD
National Coordinator for
Health Information Technology
(2004 - 2007)
Office of the National Coordinator for Health Information
Technology (ONC -- formerly ONCHIT)
Photos courtesy of U.S. Department of Health & Human Services
Karen B. DeSalvo, MD, MPH,
MSc
National Coordinator for
Health Information Technology
(2014 - 2016)
Vindell Washington, MD, MHCM
National Coordinator for
Health Information Technology
(2016 - Present)
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What is in HITECH Act?
Blumenthal D. Launching HITECH. N Engl J Med. 2010 Feb 4;362(5):382-5.
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“Meaningful Use”
“Meaningful Use”
of a PumpkinPumpkin
Image Source & Idea Courtesy of Pat Wise at HIMSS, Oct. 2009
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“Meaningful Use” of Health IT
Stage 1- Electronic capture of health information- Information sharing- Data reporting
Stage 2
Use of EHRs to improve processes of care
Stage 3
Use of EHRs to improve outcomes
Better
Health
(Blumenthal D, 2010)
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Health Information Exchange (HIE)
Hospital A Hospital B
Clinic C
Government
Lab Patient at Home
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Health Information Exchange in the U.S.
Regional Health Information Organizations
(RHIOs)
State e-Health initiatives
Nationwide Health Information Network
(NHIN)
Still ongoing efforts, but with significant
progress
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Other Public Health Informatics Applications
e-Health & m-Health m-Health in disaster management: #ThaiFlood
Data reporting to government agencies Claims & reimbursements
Diseases
Utilization statistics
Quality measures
etc.
Biosurveillance (case reporting vs. predictive)
Epidemiologic & health services research
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Google Flu Trends
Source: Google.org/FluTrends
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Thailand’s Biosurveillance
Source: www.biophics.org
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Consumer Health Informatics (CHI)
“The field devoted to informatics from a
consumer view.” (Hersh, 2009)
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M/B/H Informatics As A Field
(Hersh, 2009)
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Examples of Areas within
Consumer Health Informatics
Image Source: http://www.webmd.com/
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Examples of Areas within
Consumer Health Informatics
Image Source: http://www.greatdreams.com/cancer-cure.htm
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Examples of Areas within
Consumer Health Informatics
Image Source: http://www.hon.ch/, http://socialmarketing.blogs.com/r_craiig_lefebvres_social/2007/02/health_literacy.html
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Examples of Areas within
Consumer Health Informatics
Image Source: http://michaelcarusi.com/2012/01/01/when-you-should-not-become-a-social-media-manager/
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Examples of Areas within
Consumer Health Informatics
Image Source: http://ucedtech.wikispaces.com/Welcome
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mHealth
http://whqlibdoc.who.int/publications/2011/9789241564250_eng.pdf
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Examples of Areas within
Consumer Health Informatics
Image Source: http://nutrition.about.com/od/recipesmenus/ss/learnlabels.htm
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Class Exercise
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Roles of ICT in Consumer Health Informatics
Access to information
Networking opportunities
Education/Self-study
Personalization
Effective & efficient communications
With providers
Among patients
Empowerment
“User Experience”
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Issues in Consumer Health Informatics
Health literacy & IT literacy
Cultural diversity & sensitivity
Usability, information presentation
Impact of ICT on behavioral modifications
Integration with provider’s systems
Information exchange & interoperability
Business model
Privacy & security
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Personal Health Records (PHRs)
“An electronic application through which individuals can
access, manage and share their health information, and that
of others for whom they are authorized, in a private, secure,
and confidential environment.” (Markle Foundation, 2003)
“A PHR includes health information managed by the
individual... This can be contrasted with the clinician’s record
of patient encounter–related information [a paperchart or
EHR], which is managed by the clinician and/or health care
institution.” (Tang et al., 2006)
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Types of PHRs
Patient portal from a provider’s EHRs(“tethered” PHRs)
Online PHRs Stand-alone
Can be integrated with EHRs from multiple providers (unidirectional/bidirectional data sharing)
Stand-alone PHRs PC-based applications
USB Drive
CD-ROM or other data storage devices
Paper
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PHRs and Other Systems
(Tang et al., 2006)
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Ideal PHRs
Integrated
Accessible
Secure
Comprehensive
Accurate & current
Patient able to manage sharing & update information
Engaging & educational
User-friendly, culturally & literacy appropriate
The “Hub and Spoke” Model
(Kaelber et al., 2008)
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Use Cases of PHRs
Data entry/update by patients
Data retrieval by providers
With patient’s consent
“Break-the-glass” emergency access
Data update from EHRs
Privacy settings
Personalized patient education
Communications with providers
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Data in PHRs
(Tang et al., 2006)
(Tang et al., 2006)
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Other IT for Consumer Health
Traditional Web
MedlinePlus
Other sites
Social Media
The Usuals: MySpace, Facebook, Twitter
Blogs, forums
PatientsLikeMe
Telemedicine & Telehealth
Home monitoring/recording devices
Tele-consultations, virtual visits
http://media.nstda.or.th/video/viewVideo.php?video_id=1273
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Connecting People to a Healthy Future With
Personalized Care – Kaiser Permanente
https://www.youtube.com/watch?v=gxz9ZVvduGc
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More “Future Vision”...
Microsoft Health: Future Vision
http://www.microsoft.com/showcase/en/us/details/b112da1c-c918-
41ee-bb45-d6a553496168
NECTEC’s Smart Health
http://media.nstda.or.th/video/viewVideo.php?video_id=1273
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References Blumenthal D. Launching HITECH. N Engl J Med. 2010 Feb 4;362(5):382-5.
Blumenthal D, Tavenner M. The “meaningful use” regulation for electronic health
records. N Engl J Med. 2010 Aug 5;363(6):501-4.
Connecting for Health. The personal health working group final report. Markle
Foundation; 2003 Jul 1.
Hsiao C, Beatty PC, Hing ES, Woodwell DA. Electronic medical record/electronic health
record use by office-based physicians: United States, 2008 and preliminary 2009
[Internet]. 2009 [cited 2010 Apr 12]; Available from:
http://www.cdc.gov/nchs/data/hestat/emr_ehr/emr_ehr.pdf
Jha AK, DesRoches CM, Campbell EG, Donelan K, Rao SR, Ferris TG, Shields A,
Rosenbaum S, Blumenthal D. Use of electronic health records in U.S. hospitals. N Engl
J Med. 2009;360(16):1628-38.
Kaelber DC, Jha AK, Johnston D, Middleton B, Bates DW. A research agenda for
personal health records (PHRs). J Am Med Inform Assoc. 2008 Nov-Dec;15(6):729-36.
Schoen C, Osborn R, Huynh PT, Doty M, Puegh J, Zapert K. On the front lines of care:
primary care doctors’ office systems, experiences, and views in seven countries. Health
Aff (Millwood). 2006;25(6):w555-71.
Tang PC, Ash JS, Bates DW, Overhage JM, Sands DZ. Personal health records:
definitions, benefits, and strategies for overcoming barriers to adoption. J Am Med
Inform Assoc. 2006 Mar-Apr;13(2):121-6.